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Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression

Published online by Cambridge University Press:  17 July 2009

W. H. Denton ,
T. J. Carmody ,
A. J. Rush ,
M. E. Thase ,
M. H. Trivedi ,
B. A. Arnow ,
D. N. Klein  and
M. B. Keller
W. H. Denton*
Affiliation:
Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, TX, USA
T. J. Carmody
Affiliation:
Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, TX, USA Department of Clinical Sciences, The University of Texas Southwestern Medical Center at Dallas, TX, USA
A. J. Rush
Affiliation:
Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, TX, USA Department of Clinical Sciences, The University of Texas Southwestern Medical Center at Dallas, TX, USA
M. E. Thase
Affiliation:
Department of Psychiatry, University of Pennsylvania, PA, USA
M. H. Trivedi
Affiliation:
Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, TX, USA
B. A. Arnow
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, CA, USA
D. N. Klein
Affiliation:
Department of Psychology, Stony Brook University, Stony Brook, NY, USA
M. B. Keller
Affiliation:
Department of Psychiatry and Human Behavior, Brown University, RI, USA
*
*Address for correspondence: W. H. Denton, M.D., Ph.D., University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX75390-9121, USA. (Email: Wayne.Denton@UTSouthwestern.edu)
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Abstract

Background

Dyadic discord, while common in depression, has not been specifically evaluated as an outcome predictor in chronic major depressive disorder. This study investigated pretreatment dyadic discord as a predictor of non-remission and its relationship to depressive symptom change during acute treatment for chronic depression.

Method

Out-patients with chronic depression were randomized to 12 weeks of treatment with nefazodone, the Cognitive Behavioral Analysis System of Psychotherapy or their combination. Measures included the Marital Adjustment Scale (MAS) and the Inventory of Depressive Symptomatology – Self Report (IDS-SR30). Of 681 original patients, 316 were partnered and 171 of these completed a baseline and exit MAS, and at least one post-baseline IDS-SR30. MAS scores were analysed as continuous and categorical variables (‘dyadic discord’ v. ‘no dyadic discord’ defined as an MAS score >2.36. Remission was defined as an IDS-SR30 of ⩽14 at exit (equivalent to a 17-item Hamilton Rating Scale for Depression of ⩽7).

Results

Patients with dyadic discord at baseline had lower remission rates (34.1%) than those without dyadic discord (61.2%) (all three treatment groups) (χ2=12.6, df=1, p=0.0004). MAS scores improved significantly with each of the treatments, although the change was reduced by controlling for improvement in depression. Depression remission at exit was associated with less dyadic discord at exit than non-remission for all three groups [for total sample, 1.8 v. 2.4, t(169)=7.3, p<0.0001].

Conclusions

Dyadic discord in chronically depressed patients is predictive of a lower likelihood of remission of depression. Couple therapy for those with dyadic discord may increase remission rates.

Keywords

Chronic depressiondyadic discordmajor depressive disorderpredictors
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 3 , March 2010 , pp. 415 - 424
Copyright
Copyright © Cambridge University Press 2009

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